Posterior and anterior tilt increases the risk of failure after internal fixation of Garden I and II femoral neck fracture

Sjöholm, Pontus; Otten, Volker; Wolf, Olof; Gordon, Max; Karsten, Gustav; Sköldenberg, Olof; Mukka, Sebastian

doi:10.1080/17453674.2019.1637469

Cited by 34 publications

(53 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Osteonecrosis of femoral head and nonunion were the primary causes for reoperation after internal fixation. Furthermore, high preoperative anterior tilt or posterior tilt, low bone mineral density, patient age, gender, and higher body mass could increase the risk of reoperation in Garden I and II femoral neck fractures treated with cannulated screws 21–25 . Screw fixation could not provide a satisfactory long‐term reoperation rate in elderly patients with undisplaced femoral neck fractures.…”

Section: Discussionmentioning

confidence: 99%

Long‐Term Efficacy of Screw Fixation vs Hemiarthroplasty for Undisplaced Femoral Neck Fracture in Patients over 65 Years of Age: A Systematic Review and Meta‐Analysis

Xue

2021

Orthopaedic Surgery

View full text Add to dashboard Cite

Objective To compare the long‐term efficacy of screw fixation and hemiarthroplasty in elderly patients with undisplaced femoral neck fractures. Methods We searched Cochrane Library, EMBASE, and MEDLINE from inception to 10 June 2020 to identify studies about undisplaced femoral neck fracture in elderly patients over 65 years of age. The included studies were assessed by two researchers according to the Cochrane risk‐of‐bias criteria and Newcastle–Ottawa Scale. Meta‐analysis was performed with Revman 5.3 software. The odds ratios (OR) and mean differences (MD) were used to compare dichotomous and continuous variables. Results A total of 750 patients were included in this meta‐analysis. In elderly patients, undisplaced femoral neck fracture treated with hemiarthroplasty had a lower implant‐related complication rate (OR, 4.05 [95% CI, 2.38 to 6.89]; P < 0.00001; I2 = 0), lower reoperation rate (OR, 4.88 [95% CI, 2.84 to 8.38]; P < 0.00001; I2 = 0), and superior Harris score (WMD, −5.05 [95% CI, −7.30 to −2.80]; P < 0.0001; I2 = 0) in the early postoperative period. Although screw fixation was associated with shorter operative time (WMD, −36.22 [95% CI, −50.72 to −21.73]; P < 0.00001; I2 = 98%) and less blood loss (WMD, −165.84 [95% CI, −209.29 to −122.38]; P < 0.00001; I2 = 96%), there was no significant difference in long‐term mortality (OR, 0.65 [95% CI, 0.28 to 1.48]; P < 0.31; I2 = 75%) between these two treatments. Conclusion In elderly patients with undisplaced femoral neck fractures, hemiarthroplasty provided a lower implant‐related complication rate, lower reoperation rate, superior hip function without increased long‐term mortality. Hemiarthroplasty should be recommended as a better alternative in such patients compared with multiple cannulated screws.

show abstract

Section: Discussionmentioning

confidence: 99%

Long‐Term Efficacy of Screw Fixation vs Hemiarthroplasty for Undisplaced Femoral Neck Fracture in Patients over 65 Years of Age: A Systematic Review and Meta‐Analysis

Xue

2021

Orthopaedic Surgery

View full text Add to dashboard Cite

show abstract

“…We did not analyze anterior tilt in this cohort because the anterior tilt was not measured in any of the patients. Sjöholm et al analyzed the influence of 30° and 40° posterior tilt [9]. Posterior tilt of 30° and 40° show an HR of 3.3 (95% CI 1.7-6.4) and 7.0 (95% CI 2.4-21), respectively.…”

Section: Discussionmentioning

confidence: 99%

“…A posterior tilt may be of consequence for the stability of the fracture. Most of the studies describing the clinical relevance of a posterior tilt show that it influences the outcome of treatment, with osteosynthesis of undisplaced FNFs [3][4][5][6][7][8][9]. However, the correlation between posterior tilt and treatment failure is not always clear and undisputed [10,11].…”

Section: Introductionmentioning

confidence: 99%

More than 20° posterior tilt of the femoral head in undisplaced femoral neck fractures results in a four times higher risk of treatment failure

Kalsbeek

Walsum

Roerdink

et al. 2021

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

Purpose In this study, we aimed to determine the correlation between the preoperative posterior tilt of the femoral head and treatment failure in patients with a Garden type I and II femoral neck fracture (FNF) treated with the dynamic locking blade plate (DLBP). Methods Preoperative posterior tilt was measured in a prospective documented cohort of 193 patients with a Garden type I and II FNF treated with the DLBP. The correlation between preoperative posterior tilt and failure, defined as revision surgery because of avascular necrosis, non-union, or cut-out, was analyzed. Results Patients with failed fracture treatment (5.5%) had a higher degree of posterior tilt on the initial radiograph than the patients with uneventful healed fractures: 21.4° and 13.8°, respectively (p = 0.03). The failure rate was 3.2% for Garden type I and II FNF with a posterior tilt < 20° and 12.5% if the preoperative posterior tilt was ≥ 20°. A posterior tilt of ≥ 20° was associated with an odds ratio of 4.24 (95% CI 1.09–16.83; p = 0.04). Conclusion Garden type I and II FNFs with a significant preoperative posterior tilt (≥ 20°) seem to behave like unstable fractures and have a four times higher risk of failure. Preoperative posterior tilt ≥ 20° of the femoral head should be considered as a significant predictor for failure of treatment in Garden type I and II FNFs treated with the DLBP.

show abstract

“…There are a number of studies that have sought to predict the failure of undisplaced or minimally displaced FNF treated with IF. Posterior and ventral tilt on the lateral radiograph has been found to be a predictor of failure [ 19 , 20 ]. Other risk factors include advanced age, nutritional status, and capital impaction [ 21 , 22 ].…”

Section: Discussionmentioning

confidence: 99%

A cohort study comparing internal fixation for undisplaced versus hip arthroplasty for displaced femoral neck fracture in the elderly: a pilot study for a clinical trial

Mukka

Sjöholm

Aziz

et al. 2020

Pilot Feasibility Stud

Self Cite

View full text Add to dashboard Cite

Introduction: The literature regarding undisplaced femoral neck fractures (FNF) is sparse. The aim of this prospective feasibility study is to compare the clinical outcome after undisplaced FNF treated with internal fixation (IF) and displaced FNF treated with hip arthroplasty. We hypothesized that hip arthroplasty would give a lower incidence of reoperations. Methods: A total of 235 patients were included with a median age of 84 years (range 65-99). A consecutive series of 65 patients with undisplaced FNF were treated with IF, and 170 patients with displaced FNF were treated with either a total hip arthroplasty or a hemiarthroplasty. Follow-up interviews were conducted at 1 year using the Harris Hip Score (HHS), WOMAC, and pain numeric rating scale (PNRS). The minimum follow-up time was 22 months. There was no difference in baseline data between the groups. Results: Nineteen (8%) hips required reoperation at least once at a mean of 6 months (range 0-35). The rate of reoperation was higher in the IF group compared to the hip arthroplasty group (13.8% vs. 5.9%, 95% CI 0.9-6.4). The overall 1-year and 2-year mortality was 28% and 40%, respectively, with no difference between the groups. The most common reasons for reoperations in the IF group were non-union and avascular necrosis, and 6 patients were treated with hip or excision arthroplasty. In the arthroplasty group, the most common indications were deep infection and dislocation. We did not find any differences between the groups in terms of HHS, WOMAC, and PNRS. Conclusions: In this feasibility study, we found no differences in patient-reported outcomes between the groups although IF required a higher rate of reoperations. Further randomized trials are needed to establish the optimal treatment of undisplaced FNF in the elderly.

show abstract

Posterior and anterior tilt increases the risk of failure after internal fixation of Garden I and II femoral neck fracture

Cited by 34 publications

References 16 publications

Long‐Term Efficacy of Screw Fixation vs Hemiarthroplasty for Undisplaced Femoral Neck Fracture in Patients over 65 Years of Age: A Systematic Review and Meta‐Analysis

Long‐Term Efficacy of Screw Fixation vs Hemiarthroplasty for Undisplaced Femoral Neck Fracture in Patients over 65 Years of Age: A Systematic Review and Meta‐Analysis

More than 20° posterior tilt of the femoral head in undisplaced femoral neck fractures results in a four times higher risk of treatment failure

A cohort study comparing internal fixation for undisplaced versus hip arthroplasty for displaced femoral neck fracture in the elderly: a pilot study for a clinical trial

Contact Info

Product

Resources

About